Mycetoma is a disfiguring, chronic granulomatous infection which affects the skin and the underlying subcutaneous tissue. We present an atypical case of recurrent mycetoma without ulceration, in a 35-year-old immunocompetent male caused by Scedosporium apiospermum sensu stricto and Madurella grisea, occurring at two separate anatomical sites.

Introduction

Tumoral calcinosis is an uncommon disorder characterized by the development of calcified masses within the peri-articular soft tissues of large joints, but rarely occurs within the hand.

Case presentation

We present the case of a 31-year-old pregnant Indian woman with a three-month history of painful swelling within the tip of her right middle finger following a superficial laceration. She was otherwise well and had normal serum calcium and phosphate levels. Plain radiography demonstrated a dense, lobulated cluster of calcified nodules within the soft tissues of the volar pulp space, consistent with a diagnosis of tumoral calcinosis. This diagnosis was confirmed on the basis of the histopathological examination following surgical excision.

Conclusion

To the best of our knowledge, we present the only reported case of acral tumoral calcinosis within the finger, and the first description of its occurrence during pregnancy. We review the etiology, pathogenesis and treatment of tumoral calcinosis.

A 41-year-old female presented with a 3-month history of gradually worsening anterior knee pain, swelling and inability to flex the knee. Magnetic resonance imaging (MRI) revealed a large intra-articular cystic swelling anterior to the anterior cruciate ligament (ACL), extending into the Hoffa's infrapatellar fat pad. Following manipulation under anaesthesia and arthroscopic debridement of the cyst, the patient's symptoms were relieved with restoration of normal knee motion. ACL ganglion cysts are uncommon intra-articular pathological entities, which are usually asymptomatic and diagnosed incidentally by MRI. This is the first reported case of an ACL cyst being so large as to cause a mechanical block to knee flexion.

Introduction

A synovial chondromatosis is a rare benign neoplasm on the synovium. Although described as a benign disease, it can be very destructive and can cause severe osteoarthritis and pain. To the best of our knowledge, we report the first known case of an extensive presentation of this intra-articular and extra-articular disease of the knee joint.

Case presentation

A 49-year-old Caucasian man presented with right knee pain and stiffness caused by diffuse intra-articular and extra-articular synovial chondromatosis. He underwent careful preoperative imaging and planning followed by a two-stage arthroscopic and open procedure in order to completely eradicate the disease. He has regained full range of movement, but continues to experience residual pain due to severe osteoarthritis.

Conclusions

Although synovial chondromatosis is described as a benign disease, it can be very destructive and debilitating. A challenging management dilemma arises when confronted with both synovial chondromatosis and osteoarthritis.